PERITONEAL FIBROSIS IN CIRRHOTICS TREATED WITH PERITONEOVENOUS SHUNTING FOR ASCITES - AN AUTOPSY STUDY WITH CLINICAL CORRELATIONS

Of 554 cirrhotics autopsied during 1975-1993, 69 had had peritoneoveno us shunts. Generalized peritoneal fibrosis with cocoon formation was f ound in 26 (38%) of those with shunts but in only one of 485 without s hunts (P = 0.00002), In 14/26 the fibrosis was asymptomatic, an incide ntal autopsy finding. Intestinal obstruction in 12/26 (46%), the only symptomatic manifestation, was fatal in five. The etiology of peritone al fibrosis in shunted patients is unknown, The 26 patients with fibro sis had more prior abdominal operations, complicated abdominal wall he rnias, and active biliary tract inflammations; these features differen tiated them from the 43 patients without fibrosis. Scores in a ''perit oneal complication index,'' that considered multiple risks in the same patients? were significantly higher in those with fibrosis. In additi on to these peritoneal injuries or inflammations, the faster ascitic f luid circulation in shunted patients may have increased deposition of fibrin upon the peritoneum. Fibrogenic cytokines, thus spread througho ut the abdomen from local sites, may have converted fibrinous adhesion s to generalized peritoneal fibrosis.